Evidence map›Paper›PMID 38937394›Full record

SynthesisDrugs2024

Paracetamol Combination Therapy for Back Pain and Osteoarthritis: A Systematic Review and Meta-Analyses.

Zhiying Cao, Kaiyue Han, Hanting Lu, Sandalika Illangamudalige, Christina Abdel Shaheed, Lingxiao Chen, Andrew J McLachlan, Asad E Patanwala, Christopher G Maher, Chung-Wei Christine Lin and 3 more

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Drugs, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Zhiying CaoSydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.ORCID http://orcid.org/0009-0007-6927-8907
Kaiyue HanSydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.ORCID http://orcid.org/0009-0009-1090-199X
Hanting LuSydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
Sandalika IllangamudaligeSydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
Christina Abdel ShaheedInstitute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia.ORCID http://orcid.org/0000-0003-1258-5125
Lingxiao ChenDepartment of Orthopedics, Shandong University Centre for Orthopedics, Advanced Medical Research Institute, Qilu Hospital of Shandong University, Shandong University, Jinan, China.ORCID http://orcid.org/0000-0001-7721-0493
Andrew J McLachlanSydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia.ORCID http://orcid.org/0000-0003-4674-0242
Asad E PatanwalaSydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia.ORCID http://orcid.org/0000-0003-3999-4703
Christopher G MaherInstitute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia.ORCID http://orcid.org/0000-0002-1628-7857
Chung-Wei Christine LinInstitute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia.ORCID http://orcid.org/0000-0001-6192-7238
Lyn MarchNorthern Clinical School, The University of Sydney, Sydney, NSW, Australia.ORCID http://orcid.org/0000-0003-1736-8111
Manuela L FerreiraFaculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia.ORCID http://orcid.org/0000-0002-3479-0683
Stephanie MathiesonFaculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia. stephanie.mathieson@sydney.edu.au.ORCID http://orcid.org/0000-0002-7335-8842

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectiveAlthough paracetamol (acetaminophen) combined with other analgesics can reduce pain intensity in some pain conditions, its effectiveness in managing low back pain and osteoarthritis is unclear. This systematic review investigated whether paracetamol combination therapy is more effective and safer than monotherapy or placebo in low back pain and osteoarthritis.

methodsOnline database searches were conducted for randomised trials that evaluated paracetamol combined with another analgesic compared to a placebo or the non-paracetamol ingredient in the combination (monotherapy) in low back pain and osteoarthritis. The primary outcome was a change in pain. Secondary outcomes were (serious) adverse events, changes in disability and quality of life. Follow-up was immediate (≤ 2 weeks), short (> 2 weeks but ≤ 3 months), intermediate (> 3 months but < 12 months) or long term (≥ 12 months). A random-effects meta-analysis was conducted. Risk of bias was assessed using the original Cochrane tool, and quality of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

resultsTwenty-two studies were included. Pain was reduced with oral paracetamol plus a non-steroidal anti-inflammatory drug (NSAID) at immediate term in low back pain (paracetamol plus ibuprofen vs ibuprofen [mean difference (MD) - 6.2, 95% confidence interval (CI) -10.4 to -2.0, moderate evidence]) and in osteoarthritis (paracetamol plus aceclofenac vs aceclofenac [MD - 4.7, 95% CI - 8.3 to - 1.2, moderate certainty evidence] and paracetamol plus etodolac vs etodolac [MD - 15.1, 95% CI - 18.5 to - 11.8; moderate certainty evidence]). Paracetamol plus oral tramadol reduced pain compared with placebo at intermediate term for low back pain (MD - 11.7, 95% CI - 19.2 to - 4.3; very low certainty evidence) and osteoarthritis (MD - 6.8, 95% CI - 12.7 to -0.9; moderate certainty evidence). Disability scores improved in half the comparisons. Quality of life was infrequently measured. All paracetamol plus NSAID combinations did not increase the risk of adverse events compared to NSAID monotherapy.

conclusionsLow-to-moderate quality evidence supports the oral use of some paracetamol plus NSAID combinations for short-term pain relief with no increased risk of harm for low back pain and osteoarthritis compared to its non-paracetamol monotherapy comparator.

Indexed as

AcetaminophenAnalgesics, Non-NarcoticAnti-Inflammatory Agents, Non-SteroidalLow Back PainOsteoarthritisAdministration, OralDrug Therapy, CombinationHumansIbuprofenQuality of LifeRandomized Controlled Trials as TopicAcetaminophenAnalgesics, Non-NarcoticAnti-Inflammatory Agents, Non-SteroidalIbuprofen

Identifiers

PMID38937394
PMCPMC11343817

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.